1984, 08-06 Permit App: 00002059 Water SoftenerPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
I certify that the above information as submitted by me 1s true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OFAPPLICATION 8/6/84
OWNER OR AGENT Soft Water Service Coo. DATE
1 Owner's Name (Last) (First) (M)
Department Use OnI v�Q59
KLINKE , Paul D
Project No.
2 Project Add?ess (Not Mailing Address) Space Zip
5S3 Wood / ii/7 D/ 99212
3 City/Community
Spokane
State
WA
Subdiv /Plat Name /1\71e
CCS 4- c.c/oefi P/
4 Assessor Parcel No.
2363/ — //176
Lot
Block
16 Contractor Firm Name
Soft Waterservice Co.
Stree Address
E. 25 Third
17 Zip
99202
City
Spokane
State
WA
Phone
( 509 455-5080
18 Contact Person
I License No.
Phone If different than above
8 Owner/Agent Of different than p1 above)
Bust
ess Address
9 Zip
City
State
Phone
( )
15 Describe Work: New Addition /Alteration 0 Replace/ Repair ❑
Total Number
of Fixtures:
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
9 Ber SInk(s):
Drinking Fountain(s):
Floor Drain(s):
Washing Machine(s):
10 Dsh Wahr(s):
Garb Disp(s):
Klt SInk(s):
Lndry Tray(s):
Sew Eject(s):
11 Urinal(s):
Wt Closet(s):
Lay(s):
Shower(s):
I Tub(s):
I Bidet is):
0 Other: Type; Water Softener
J
12 Waste/Grease Interceptor(s):
Z
L 13 Sewer Y N Septic/Health No.:
J
L
D 14 Electric Water Heater(s):
5
Drains -Roof:
D
2: 15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N
16 Lawn Sprinkler System(s), including backflow device on any one meter:
17 Vacuum breakers or backflow devices In excess of Ilne 16:1-5:
(Or) 5+:
I certify that the above information as submitted by me 1s true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OFAPPLICATION 8/6/84
OWNER OR AGENT Soft Water Service Coo. DATE